The Office of Child Care Licensing uses progressive enforcement when evaluating concerns at facilities. Several areas are reviewed to determine what steps need to be taken a facility cannot meet substantial compliance.

Factors that are considered include:

• Number of deficiencies
• Repeat deficiencies
• Length of time of occurrences
• Actual harm
• Potential for harm
• Patterns of deficiencies (e.g., multiple centers)
• Aggravators / mitigators
• Size of facility
• Scope and severity of each deficiency
• Services
• Transportation, field trips and medication

Surveyors work with facilities to assist in understanding why deficiencies have occurred and participate in the resolution to help the provider to develop a plan that explains how these issues will not happen again.

Options that are available to the Department are as follows:

• Giving technical assistance
• Holding Provider Meetings
• Assessing civil money penalties
• Limiting services and/or hours of operation
• Temporarily suspending licenses
• Denying licenses
• Revoking licenses

Notices of Enforcement are issued only when a facility has not been able to correct deficiencies within a reasonable time frame agreed to by both the Provider and the Department. This process starts after all other options to assist the Providers reach substantial compliance fail.

The following scope and severity Enforcement Matrix is used to determine the types of enforcement actions to be taken. These abbreviations are used in the Matrix:

POC: Plan of Correction
TRO: Temporary Restraining Order

Enforcement Matrix

Severity / Scope	Isolated	Pattern	Widespread
Level 4: Immediate Jeopardy to Resident/Client Health or Safety	J              POC Required: Cat 2 Optional: Cat 3 Optional: Cat 1	K              POC Required: Cat 3 Optional: Cat 2 Optional: Cat 1	L              POC Required: Cat 3 Optional: Cat 2 Optional: Cat 1
Level 3: Actual Harm that is not Immediate Jeopardy	G              POC Required: Cat 2 Optional: Cat 3 Optional: Cat 1	H              POC Required: Cat 2 Optional: Cat 3 Optional: Cat 1	I              POC Required: Cat 2 Optional: Cat 1 Optional: Cat 3
Level 2: No Actual Harm with Potential for more than Minimal Harm that is not Immediate Jeopardy	D              POC Required: Cat 1 Optional: Cat 2	E              POC Required: Cat 1 Optional: Cat 2	F              POC Required: Cat 2 Optional: Cat 1 Optional: Cat 3
Level 1: No Actual Harm with Potential for Minimal Harm	A              POC No Enforcement Remedies Commitment to Correct	B            POC Optional: Cat 1	C              POC Optional: Cat 1

Enforcement Remedy Categories^1,2

Category 13 Directed POC Monitoring Inservice Directed Inservice

Category 23 Civil Money Penalties Provisional License Suspension Stipulation Intermediate Sanctions - Child Care

Category 3 Injunction/TRO Denial Revocation Temporary Manager Intermediate Sanctions - Child Care

¹ May also pursue a Cease and Desist or an Injunction/Temporary Restraining Order (TRO)against anyone operating a facility without a license, or for violations that place the health and safety of one or more consumer, client, resident and/or patient at risk.

² The matrix is not used for unlicensed or over capacity entities unless there are health and safety deficiencies.

³ Can be done by a Provider Meeting. All others are by Stipulation or Legal Order.